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Unknown Primary Tumors, Lymph Nodes, Axilla
Background: Cancer of unknown primary involving axillary lymph nodes (CUPAx) is a very rare type of cancer. There are still many challenges about the management and outcome of the disease. This retrospective study is an attempt to assess the overall survival and the outcome of CUPAx in Iranian women.
Methods: Based on inclusion and exclusion criteria, 20 patients primarily diagnosed with CUPAx referred to our breast multidisciplinary team (MDT) sessions between July 2010 and December 2016 were evaluated. The patients were categorized into three groups based on the types of treatment: mastectomy and radiation therapy, radiation therapy, and observation group.
Results: The mean age of the subjects was 52 ± 7.91 years (range: 42-74). The results manifested significant differences between the outcomes of three types of treatments. The patients who received both mastectomy and radiotherapy had a higher survival rate and no sign of the disease compared with other groups (P= 0.03). The median survival time in the mastectomy group was 78 months and 23 months for the group with no mastectomy (95% CI: 7.64-38.36) (P <0.001).
Conclusion: The result suggested that mastectomy was effective in lowering the risk of disease progression in Iranian women diagnosed with CUPAx and highly suspicious breast origin. More studies on larger sample groups are needed.
2. Pentheroudakis G, Lazaridis G, Pavlidis N. Axillary nodal metastases from carcinoma of unknown primary (CUPAx): a systematic review of published evidence. Breast Cancer Res Treat 2010;119(1):1.
3. Pavlidis N, Pentheroudakis G. Cancer of unknown primary site. Lancet 2012;379(9824):1428-35.
4. Fayanju OM, Jeffe DB, Margenthaler JA. Occult primary breast cancer at a comprehensive cancer center. J Surg Res 2013;185(2):684-9.
5. Barton SR, Smith IE, Kirby AM, Ashley S, Walsh G, Parton M. The role of ipsilateral breast radiotherapy in management of occult primary breast cancer presenting as axillary lymphadenopathy. Eur J Cancer 2011;47(14):2099-106.
6. Sohn G, Son BH, Lee SJ, Kang EY, Jung SH, Cho SH, et al. Treatment and survival of patients with occult breast cancer with axillary lymph node metastasis: a nationwide retrospective study. J Surg Oncol 2014;110(3):270-4.
7. Lee KC, Schwartz R, Iglesis R, Vélez R, Gómez L. Occult breast cancer: report of two cases. Rev Med Chil 2006;134(9):1166-70.
8. Montagna E, Bagnardi V, Rotmensz N, Viale G, Cancello G, Mazza M, et al. Immunohistochemically defined subtypes and outcome in occult breast carcinoma with axillary presentation. Breast Cancer Res Treat 2011;129(3):867.
9. Pavlidis N, Khaled H, Gaafar R. A mini review on cancer of unknown primary site: a clinical puzzle for the oncologists. J Adv Res 2015;6(3):375-82.
10. McMahon K, Medoro L, Kennedy D. Breast magnetic resonance imaging: an essential role in malignant axillary lymphadenopathy of unknown origin. Australas Radiol 2005;49(5):382-9.
11. De Bresser J, De Vos B, Van der Ent F, Hulsewe K. Breast MRI in clinically and mammographically occult breast cancer presenting with an axillary metastasis: a systematic review. Eur J Surg Oncol 2010;36(2):114-9.
12. Walker GV, Smith GL, Perkins GH, Oh JL, Woodward W, Yu TK, et al. Population?based analysis of occult primary breast cancer with axillary lymph node metastasis. Cancer 2010;116(17):4000-6.
13. Yamaguchi H, Ishikawa M, Hatanaka K, Uekusa T, Ishimaru M, Nagawa H. Occult breast cancer presenting as axillary metastases. Breast 2006;15(2):259-62.
14. Yirmibe?o?lu E, Tekin E, Memi? L, Yamac D, Taneri F, Erkal H?. A patient with occult breast cancer presenting with an axillary lymph node metastasis and a synchronous contralateral breast cancer. Breast 2005;14(2):157-62.
15. Akhtar K, Ahmad M, Khan AI, Sherwani RK. Bilateral occult breast carcinoma presenting as bilateral axillary mass: An UNUSUAL presentation. J Cell Immun 2016;2(2):98-100.
16. Anderson SR, Scarborough CS. Axillary node metastatic carcinoma without definitive primary: a case report. Int J Surg Case Rep 2016;25:196-8.
17. Khandelwal AK, Garguilo GA. Therapeutic options for occult breast cancer: a survey of the American Society of Breast Surgeons and review of the literature. Am J Surg 2005;190(4):609-13.